Pediatric Cardiac Intensive Care Unit Research Articles

Persistent Pulmonary Hypertension of Newborn: Analysis of 494 cases in a Tertiary Care Hospital

Introduction: Persistent pulmonary hypertension (PPHN) or persistent fetal circulation (PFC) is a commonly encountered problem in neonatal and pediatric cardiac intensive care units and cause significant mortality and morbidity.
 Aim/Objective : To show the outcome of patient of PPHN treated by a cheap, locally available NNF protocol.
 Methods: It was a retrospective study conducted in pediatric cardiology department of a tertiary care hospital in Dhaka, Bangladesh from February 2014 to March 2019. After diagnosis in noninvasive cardiac laboratory (NIC Lab), all cases were admitted in neonatal and pediatric cardiac intensive care units for specific management using NNF protocol. After 72 hours, echocardiography was repeated, and outcome was analyzed.
 Results: Out of total 494 cases, 80.56% cases were diagnosed at first week and 4.45% cases were diagnosed at 3rd week of life. Male patients (60.32%) outnumbered female. Babies were delivered by caesarean section in 92.31% cases. PPHN was found alone in 24.69% cases and rest along with other less severe congenital heart diseases. Severe pulmonary hypertension was observed in 63.56% cases. Right ventricular volume was increased in 93.52% cases. Hundred percent neonates were treated with high flow oxygen therapy by optiflow/ nasal cannula/ head box. Antifailure treatment was offered in 73.27% cases, pulmonary vasodilators in 59.51% cases, inotropes in 15.18% cases. Outcome of treatment was analyzed after 72 hours by repeat echocardiography. Four hundred and seventy one (95.34%) cases were cured completely and only 1.01% expired.
 Conclusion: PPHN is a life threatening condition in neonate only. Early diagnosis and proper management is must for survival. Management by low cost NNF protocol was found effective with 95.34% cure rate and only 1.01% mortality. This protocol may be used for treatment of PPHN in low cost set up.
 J Bangladesh Coll Phys Surg 2020; 38(4): 176-184

Does size matter? The impact of a small but targeted cleaning training intervention within a paediatric ward

SummaryBackgroundCleaning is a critical tool for infection prevention and control, and is a key intervention for preventing healthcare associated infections (HCAIs) and controlling intermediate transmission routes between patient and environment. This study sought to identify potential areas of weakness in clinical surface cleaning, and assess the effectiveness of a staff group specific training intervention.ObservationsOne-hundred hours of audit observations in a paediatric cardiac intensive care unit (CICU) assessed surface cleaning technique of healthcare staff within bedspaces. Cleaning was assessed with a 5-component bundle, with each cleaning opportunity scored out of five.Training InterventionFifty hours of audit observations before and after a training intervention tested the efficacy of a staff group specific education intervention. The intervention was developed and implemented for 69% of nurses and 100% of cleaners.ResultsOne hundred and eighteen cleaning opportunities were observed before training, and scored an average of 2.4. One hundred and twenty-one cleaning opportunities were observed after training and scored an average 3.0. On average, before training, each cleaning opportunity by nurses and cleaners fulfilled 2.4 and 2.5, respectively, of the 5 bundle components. Following training, this improved to 3.3 and 2.9 respectively. There was a statistically significant improvement in bundle scores for nurses (P=.004) and cleaners (P=.0003).ConclusionsSurface wipe methods were inconsistent between all staff groups. The education based intervention resulted in a small improvement in most of the cleaning components. This study has identified how a small but targeted cleaning training intervention can have a significant (P= <.0001) impact on cleaning bundle compliance for both nurses and cleaners.

Risk Factors for Mortality in Pediatric Cardiac Intensive Care Unit

Risk Factors for Mortality in Pediatric Cardiac Intensive Care Unit

A Comprehensive Clinical Genetics Approach to Critical Congenital Heart Disease in Infancy

To investigate the frequency of genetic diagnoses among infants with critical congenital heart disease (CHD) using a comprehensive cardiovascular genetics approach and to identify genotype-phenotype correlations. A retrospective chart review of patients evaluated by cardiovascular genetics in a pediatric cardiac intensive care unit from 2010 to 2015 was performed. Infants with CHD who were <1month of age were included. CHD was classified using structured phenotype definitions. Cardiac and noncardiac phenotypes were tested for associations with abnormal genetic testing using χ1 and Fisher exact tests. Genetic evaluation was completed in 293 infants with CHD, of whom 213 had isolated congenital heart disease (iCHD) and 80 had multiple congenital anomalies. Overall, the yield of abnormal genetic testing was 26%. The multiple congenital anomalies cohort had a greater yield of genetic testing (39%) than the iCHD cohort (20%) (OR 2.7). Using a non-hierarchical CHD classification and excluding 22q11.2 deletion and common aneuploidies, right ventricular obstructive defects were associated with abnormal genetic testing (P=.0005). Extracardiac features associated with abnormal genetic testing included ear, nose, and throat (P=.003) and brain (P=.0001) abnormalities. A diagnosis of small for gestational age or intrauterine growth retardation also was associated with abnormal genetic testing (P=.0061), as was presence of dysmorphic features (P=.0033, OR 3.5). Infants without dysmorphia with iCHD or multiple congenital anomalies had similar frequencies of abnormal genetic testing. The present study provides evidence to support a comprehensive cardiovascular genetics approach in evaluating infants with critical CHD while also identifying important genotype-phenotype considerations.

Association between time of day and CPR quality as measured by CPR hemodynamics during pediatric in-hospital CPR

IntroductionPatients who suffer in-hospital cardiac arrest (IHCA) are less likely to survive if the arrest occurs during nighttime versus daytime. Diastolic blood pressure (DBP) as a measure of chest compression quality was associated with survival from pediatric IHCA. We hypothesized that DBP during CPR for IHCA is lower during nighttime versus daytime. MethodsThis is a secondary analysis of data collected from the Pediatric Intensive Care Quality of Cardiopulmonary Resuscitation Study. Pediatric or Pediatric Cardiac Intensive Care Unit patients who received chest compressions for ≥1 min and who had invasive arterial BP monitoring were enrolled. Nighttime was defined as 11:00PM to 6:59AM and daytime as 7:00AM until 10:59PM. Primary outcome was attainment of DBP ≥ 25 mmHg in infants <1 year and ≥30 mmHg in older children. Secondary outcomes were mean DBP, ROSC, and survival to hospital discharge. Univariable and multivariate analyses evaluated the relationships between time (nighttime vs. daytime) and outcomes. ResultsBetween July 1, 2013 and June 30, 2016, 164 arrests met all inclusion/exclusion criteria: 45(27%) occurred at nighttime and 119(73%) during daytime. Average DBPs achieved were not different between groups (DBP: nighttime 28.3 mmHg[25.3, 36.5] vs. daytime 29.6 mmHg[21.8, 38.0], p = 0.64). Relative risk of DBP threshold met during nighttime vs. daytime was 1.27, 95%CI [0.80, 1.98], p = 0.30. There was no significant nighttime vs. daytime difference in ROSC (28/45[62%] vs. 84/119[71%] p = 0.35) or survival to hospital discharge (16/45[36%] vs. 61/119[51%], p = 0.08). ConclusionsIn this cohort of pediatric ICU patients with IHCA, there was no significant difference in DBP during CPR between nighttime and daytime.

Parental Satisfaction with Communication in the Pediatric Cardiac Intensive Care Unit is Associated with Parental Anxiety and Education (GP799)

Parental Satisfaction with Communication in the Pediatric Cardiac Intensive Care Unit is Associated with Parental Anxiety and Education (GP799)

Creating a Systematic Framework Approach to Congenital Heart Disease Comprehension and Management – A Primer for the Cardiac Intensive Care Unit Provider

The pediatric cardiac intensive care unit is a high acuity setting with large heterogeneity in patient population. Many patients will have abnormal circulatory patterns being palliated surgically. Managing these patients while efficiently interfacing the several team members in the unit requires a thought framework that we outline here.

Flexible Fiber-optic Bronchoscopy-directed Interventions in Children with Congenital Heart Diseases.

ABSTRACTObjectiveIn children, pulmonary and cardiac diseases are closely associated, and their integrated evaluation is important. Flexible fiber-optic bronchoscopy (FFB) can be used for both diagnostic and therapeutic purposes in pediatric cardiac intensive care units (PCICU). The objective of this study was to evaluate the utility of FFB in children with congenital heart disease (CHD).Materials and methodsA retrospective, descriptive study was conducted at a tertiary care center in pediatric patients who underwent FFB in PCICU over a period of 6 years (2012–2017).ResultsTotal 71 bronchoscopies were done in 58 patients with CHD with median age and weight of 2.5 months and 3.4 kg, respectively. Total of 20 different cardiac lesions were present among patients who underwent FFB. While 38 (53.5%) and 30 (42.3%) procedures were performed in pre-op and postoperative patients, respectively, 3 intraoperative bronchoscopies were also performed. The main indications for FFB were persistent atelectasis (42/71), prolonged oxygen requirement (13/71), stridor (8/71), and suspected airway anomaly (6/71). Tracheobronchitis was the commonest bronchoscopy finding (51/71, 71.8%) followed by tracheobronchomalacia (27/71, 38.3%). Cause of stridor detected in 7/8 cases. Associated preoperative and postoperative respiratory complications were detected and necessary interventions were done. These included slide tracheoplasty (5/58), tracheostomy (5/58), antibiotic change based on bronchoalveolar lavage (BAL) cultures (11/71), and continued positive pressure ventilation (4/71). Nonconsequential complications were transient hypoxemia (10/71), bleeding (2/71), and transient bradycardia (1/71).ConclusionBedside FFB is a safe and a valuable diagnostic tool that also helps in guiding interventions in children with cardiac diseases.How to cite this articleSachdev A, Chhawchharia R, Gupta D, Gupta N, Joshi R, Agarwal N. Flexible Fiber-optic Bronchoscopy-directed Interventions in Children with Congenital Heart Diseases. Indian J Crit Care Med 2020;24(5):340–343.

Promoting Parent Partnership in Developmentally Supportive Care for Infants in the Pediatric Cardiac Intensive Care Unit.

Limited opportunities for parents to care for their critically ill infant after cardiac surgery can lead to parental unpreparedness and distress. This project aimed to create and test a bedside visual tool to increase parent partnership in developmentally supportive infant care after cardiac surgery. The Care Partnership Pyramid was created by a multidisciplinary team and incorporated feedback from nurses and parents. Three Plan-Do-Study-Act (PDSA) cycles tested its impact on parent partnership in care. Information about developmentally supportive care provided by parents during each 12-hour shift was extracted from nursing documentation. A staff survey evaluated perceptions of the tool and informed modifications. Changes in parent partnership during PDSA 1 did not reach statistical significance. Staff perceived that the tool was generally useful for the patient/family but was sometimes overlooked, prompting its inclusion in the daily goals checklist. For PDSA 2 and 3, parents were more often observed participating in rounds, asking appropriate questions, providing environmental comfort, assisting with the daily care routine, and changing diapers. Use of a bedside visual tool may lead to increased parent partnership in care for infants after cardiac surgery. Future projects are needed to examine the impact of bedside care partnership interventions on parent preparedness, family well-being, and infant outcomes.

Percutaneous Impella Device for Mechanical Circulatory Support in Children with Cardiogenic Shock: Long Term Outcomes

Use of temporary mechanical circulatory support (MCS) is an alternative to increase systemic blood flow avoiding the possible cardiotoxicity and long-term morbidity of inotropes and vasopressors. It is often the only option to achieve hemodynamic stability. Use of temporary MCS is increasing in frequency in children with evolution of new technologies. Recently, catheter deployed micro-axial percutaneous ventricular assist device (PC-VAD) has been approved for management of cardiogenic shock in adults. We present our experience and long-term outcomes associated with use of this device in a pediatric cardiac intensive care unit at a freestanding children's hospital. All patients treated for cardiogenic shock with PC-VAD alone between September 2014 and June 2019 were included in retrospective analysis. The device sizes used included CP device which provides up to 4.0 l/min of flow and 5.0 device which provides 5.0 l/min of flow. Demographic and support data were reviewed and reported using descriptive statistics. A total of 24 PC-VAD devices were implanted in 18 patients: CP (n=17), and 5.0 (n=7). Median patient age was 17 years (IQR 15,20), weight of 61 kg (IQR 54,75), and BSA of 1.72 m2(IQR 1.58,1.96). Median length of CP support was 5 days (IQR 4,7) and 5.0 was 12 days (IQR 11,22). The most common device related complications included site bleeding 9/24 (38%), ventricular arrhythmias 3/24 (17%) and extremity arterial thrombus 1/24 (4%), with no limb ischemia encountered. Acute renal failure requiring CRRT occurred in 5/18 (38%) patients. None of the patients sustained neurologic injury. Median ICU length of stay was 24 days (IQR 15,45) with median hospital length of stay of 35 days (26,80). The survival to ICU discharge was 89% (16/18) and survival to hospital discharge was 89% (16/18). Twelve out of eighteen (67%) patients were alive at one year. Temporary MCS for cardiogenic shock with PC-VAD shows favorable short and long-term outcomes in select pediatric patients. This type of circulatory support can be considered for management of older children with acute cardiogenic shock to achieve quicker hemodynamic stability, end-organ recovery and as a temporary bridge to recovery or clinical decision making. The risk profile in our population was low and only minor complications occurred during the treatment.

The impact of intravenous opioid shortages on postoperative pain control in a pediatric cardiac intensive care unit

The national supply of intravenous pain medications has been restricted since 2018 due to shortages. In late 2017, the ongoing shortages combined with the increased demand for alternative formulations resulted in interruptions in the supply of medications. The cascading effect of interruptions in supply caused hospitals to implement restrictive measures to extend the availability of these medications. This study aims to evaluate differences in pain control in postoperative cardiac patients due to intravenous opioid shortage at a standalone pediatric hospital. A retrospective chart review of postoperative patients in the cardiac intensive care unit at Children's National Hospital was conducted from January to September 2017 and 2018. The objective of this study is to determine if a difference in postoperative pain scores in the period before and during the national intravenous opioid shortage exists, analyzed by differences in Face, Legs, Activity, Cry, Consolability (FLACC) scores. No differences were found in mean FLACC scores for the 140 patients who were evaluated. Patients in 2017 reported faster decline of pain symptoms compared with those in 2018. No differences in baseline characteristics or secondary outcomes were noted. Pain management was better controlled immediately postoperatively in 2018 compared with 2017, but the pain was better controlled for the duration of the postoperative period in 2017.

Multidisciplinary Simulation-Based Team Training: Knowledge Acquisition and Shifting Perception

BackgroundA multidisciplinary simulation-based team training workshop was implemented to improve the knowledge and application of crisis resource management (CRM) principles in the pediatric cardiac intensive care unit. MethodsThe workshop consisted of two scenarios followed by structured debriefing. The participants were asked to complete a survey, before and three months after the workshop, evaluating the knowledge base of CRM principles and perception of team dynamics. ResultsThe initial survey was completed by 144 participants; the follow-up was completed by 72 participants. There was a significant knowledge gap before the workshop, particularly in the areas of closed-loop communication and key principles for effective communication, which improved after the workshop. There was improvement in the perception of team performance three months after the workshop. ConclusionsThis study shows that a multidisciplinary simulation-based team training in the pediatric cardiac intensive care unit improves knowledge of CRM principles in addition to improved perception of effective teamwork.

Imaging of cerebral complications of extracorporeal membrane oxygenation in infants with congenital heart disease \u2014 ultrasound with multimodality correlation

Cranial ultrasound on neonatal intensive care units is generally performed by intensive care physicians, but radiologists often provide this crucial bedside test to children on specialist paediatric cardiac intensive care units. On a paediatric cardiac intensive care unit, complex congenital cardiac conditions are commonly encountered in both pre- and postoperative scenarios, often with the use of extracorporeal membrane oxygenation (ECMO), which both increases the risks of a number of neurologic complications and results in significant changes in vascular physiology. The aim of this pictorial essay is to discuss cranial ultrasound technique, demonstrate the changes in Doppler flow profiles resulting from veno-arterial extracorporeal membrane oxygenation and congenital cardiac conditions, and illustrate commonly encountered intracranial complications of extracorporeal membrane oxygenation support in congenital cardiac care.

Use of Magnesium Sulphate in Persistent Pulmonary Hypertension of Newborn

Background: One of the common causes of respiratory distress in neonate is persistent pulmonary hypertension of newborn (PPHN) and has been estimated to occur in 2 per 1000 live born term infants.&#x0D; Objective: To evaluate the effect of injectable Magnesium Sulphate (MgSO4) in the treatment of Persistent Pulmonary Hypertension of Newborn.&#x0D; Methodology: It was a prospective, nonrandomized, clinical study conducted from August 2015 to July 2017 among 25 neonates having moderate to severe PPHN in the Pediatric Cardiac Intensive Care Unit (CICU) of Dhaka Shishu (Children) Hospital. Injectable Magnesium Sulphate was used along with other supportive management. Outcome measures include drop of pulmonary vascular resistance and increase oxygenation. Side effects of Magnesium Sulphate were observed and outcome was recorded. Data were analyzed by using SPSS version 17.&#x0D; Results: There was significant improvement of oxygenation and decrease in pulmonary vascular resistance at 72 hours after use of MgSO4 (p=000). Complications were present in 28% cases which include hypotension in 16% patients, urinary retention in 8% and altered GI function in 8% cases. Mortality was 16% among study population.&#x0D; Conclusion: MgSO4 is effective in improving oxygenation and reduction of pulmonary vascular resistance in PPHN&#x0D; Northern International Medical College Journal Vol.10 (2) Jan 2019: 370-372

Parameters affecting outcome of paediatric cardiomyopathies in the intensive care unit: experience of an Egyptian tertiary centre over 7 years

ABSTRACT Introduction: Paediatric cardiomyopathies are rare but serious and often life-threatening conditions. In the absence of cardiac transplant and ventricular assist device as treatment options in our region, it is very important to identify patients at higher risk. The aim of this study was to determine the outcome of patients diagnosed with cardiomyopathies and their prognostic indicators. Patients and methods: This study included 92 cases representing all patients diagnosed with cardiomyopathy who were admitted into the pediatric cardiac intensive care unit during the period from January 2012 to September 2018. The patients were classified into two groups according to the outcome: the first group comprised 69 patients who survived, and the second group comprised 23 patients who died. All medical records were reviewed, and data were recorded and analysed. Results: Patients with cardiomyopathies represented 8.6% (92/1071) of all patients with cardiac diseases who were admitted in the study period and in the target age group (0.5–12 years). Dilated cardiomyopathy (DCM) was the most frequent type of cardiomyopathy among the admitted patients (80 patients), while 6 patients were diagnosed with hypertrophic cardiomyopathy (HCM), 4 were diagnosed with restrictive cardiomyopathy (RCM), and only 2 were diagnosed with mixed DCM-RCM. Seventy patients required inotropic support (76.1%). Assisted mechanical ventilation was used on 15 patients (16.3%). Twenty-three patients (25.0%) died during the 7-year study period. Conclusions Conclusions The occurrence of hypotension, abnormally high liver enzymes, the need for mechanical ventilation and the need for multiple inotropic drugs were found to be statistically significant predictors of mortality, while age, sex, fractional shortening, ejection fraction, presence of mitral regurgitation, mural thrombus, electrolyte disturbance and arrhythmias did not predict or affect patients’ outcomes.

Approach to circulation after cardiac surgery in children

Pediatric intensivists are called to patient bedsides in the pediatric cardiac intensive care unit (CICU) after congenital cardiac surgery for low blood pressure (BP) and/or poor perfusion, acute change in heart rate (HR) or rhythm, surgical site bleeding or increased chest tube output, anuria or oliguria, oxygen desaturation less than expected or metabolic acidosis with rising lactic acid and base deficit. Causes of acute circulatory failure after cardiac surgery are divided into four categories which must be considered when approaching the patient in CICU (Table 1).Assessing cardiac output in CICU remains challenging, hemodynamic parameters are usually monitored, along with physical examination, i.e. HR, BP, right and left atrial pressures. There are surrogate markers i.e., mixed venous saturation, brain and renal NIRS, toe temperature, urine output, and then laboratory workup to determine acidosis due to end-organ dysfunction. Echocardiography can confirm low cardiac output syndrome (LCOS) occurs after cardiac surgery with the following major indicators; abnormal ventricular-vascular interaction after bypass, the functionally univentricular circulation, abnormal diastolic function after surgery to the right heart and residual anatomic lesions.1 The limited support tools that are available to manage circulatory failure post cardiac surgery in the CICU are the following: Medications: High labile pulmonary vascular tone (PVR) occurs in patients with pulmonary over-circulation i.e., ASD (atrial septal defect), VSD (ventricular septal defect), PDA (patent ductus arteriosus) and AV canal (atrioventricular canal). Pulmonary venous hypertension, i.e. TAPVR with obstruction, HLHS with restrictive atrial communication and in the univentricular heart after Norwood, shunt or PA band has unstable PVR. Functionally univentricular hearts don't tolerate increased SVR and at the same time, decreased SVR may not be desirable for patients who have fixed systemic or pulmonary obstruction. There are a wide variety of medications to use, but essentially two, milrinone2,3 and epinephrine are very important and widely used. Milrinone is routinely used after cardiac surgery to minimize the LCOS, which works in a receptor independent manner and is synergistic to beta-adrenergic ionotropic effect. Most patients benefit from low dose epinephrine for decreased cardiac function. Nitroprusside is effective where after-load is high, a low dose should always be started titrating to the optimal BP. Generally, there is no role of dopamine in these patients.4 Ventilation-cardiopulmonary interaction: Ventilation at functional residual capacity needs to be targeted. Managing rhythm: Recognition of rhythm is a crucial aspect of care. It is equally important to pay attention to the appropriate heart rate. Extracorporeal mechanical support: The last resort is to put the patient on extracorporeal membrane oxygenation.In summary, the past two decades have seen important advances in our understanding of the circulatory physiology of infants and children post cardiac surgery. When approaching the patients with cardiovascular dysfunction, it is essential to approach the cardiopulmonary system in its entirety, rather than consider the heart, lungs, or peripheral circulation as isolated elements. Working towards one common goal of optimizing systemic oxygen delivery and emphasizing anticipatory intensive care tailored to individual patients with the need for early, targeted investigation and intervention is essential when patients are not progressing as expected.

3.23 CLEARING THE CONFUSION: IDENTIFYING KNOWLEDGE GAPS IN PEDIATRIC DELIRIUM AMONG MEDICAL PROFESSIONALS WORKING IN INTENSIVE CARE UNITS

Despite the high occurrence rates of pediatric delirium in intensive care units (ICUs)—30 percent in pediatric ICUs and close to 60 percent in pediatric cardiac ICUs—many providers are not comfortable with identifying and managing delirium. The aim of this study was to identify specific areas for practice improvement in the identification and treatment of pediatric delirium among critically ill youth. The authors hypothesized that critical care staff would identify a lack of standardized approach to pediatric delirium and discomfort related to this area of practice and identify opportunities for ongoing education and collaboration with psychiatric consult teams.

Impact of Cardiopulmonary Bypass and Aorta Cross Clamp Time on the Length of Mechanical Ventilation after Cardiac Surgery among Children: A Saudi Arabian Experience.

AimSeveral factors determine the perioperative outcome besides the nature of the congenital heart defect. Prolonged mechanical ventilation (PMV) is a major factor that determines mortality, length of stay (LOS), residual disability, and other functional outcomes. We aim to determine the clinical variables predicting PMV and LOS in hospital, and specifically the impact from the duration of cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC).MethodWe conducted a retrospective review of the medical records of 413 children consecutively admitted to the Pediatric Cardiac Intensive Care Unit (PCICU) in one year at a single center. We collected demographic information (e.g., age, gender, and weight), perioperative variables, clinical outcomes, length of mechanical ventilation, high-frequency ventilator use, and mortality. We used logistic regression to analyze the data. PMV was defined as mechanical ventilation for longer than seven days.ResultsA total of 410 records were included in our study. We found no statistically significant association between CPB time and mechanical ventilation days. Forty-seven children had PMV, 362 did not have PMV. We found no statistically significant association between CPB time and mechanical ventilation days after adjusting for covariates. Reanalyzing the data with PMV defined as longer than four days produced the same results. Using a regression model to assess the variables via the least absolute shrinkage and selection operator for feature selection, we found no statistically significant association between ACC time and mechanical ventilation days after adjusting for covariates.ConclusionAccording to our results, CPB and ACC time are not associated with PMV or prolonged hospital LOS.

Safety and Efficacy of Non-invasive Inhaled Nitric Oxide in Pediatric Cardiac Intensive Care Unit.

Background: The efficacy of inhaled nitric oxide (iNO) for treatment of postoperative hypoxemia and increased pulmonary vascular resistance has been documented in a limited capacity in small randomized control studies. There is no data regarding the use of iNO with non-invasive ventilation. We review our center experience with use of iNO non-invasively in pediatric patients in our cardiac ICU and assess the safety and utility of no-invasive delivery of iNO. Method: Retrospective study of patients treated with iNO in the cardiac ICU between 2010-2016. Detailed data was …

Thromboembolic Events in Children after Invasive Procedures in a Pediatric Cardiac Intensive Care Unit

Introduction: Thromboembolic events are known complications associated to central venous catheters and arterial catheterization. The exact mechanism of thrombus formation not completely understood, but it has been suggested that intimal flaps and dissection can occur after direct vessel puncture, which can lead to occlusion of the true lumen and predispose patient to thrombosis and limb ischemia. Thromboembolic complications are particularly important in the pediatric population because it can be associated with …